早期不同时机显微夹闭手术治疗破裂颅内动脉瘤疗效及预后因素分析

Analysis of curative effect and prognostic factors of early microclamping operation at different times for ruptured intracranial aneurysms

目的探究不同时机显微夹闭手术治疗颅内动脉瘤(IA)的疗效并分析影响预后的因素。方法选择2017年1月至2019年1月于宜宾市第一人民医院神经外科接受显微夹闭手术治疗IA的102例患者,其中男性49例,女性53例;年龄33~72岁,平均年龄56.54岁。比较不同时机(24 h内、48 h内、72 h内)显微夹闭手术患者的一般资料、术后动脉瘤夹闭情况、术后并发症发生情况、治疗效果及患者预后情况;单因素及多因素Logisitic回归分析影响IA患者预后的因素;根据筛选出的独立危险因素构建列线图预测模型并验证。结果不同时机显微夹闭手术患者的一般资料差异无统计学意义(P>0.05);24 h内手术的患者动脉瘤完全夹闭率、恢复良好率、预后良好率显著高于48 h内和72 h内手术的患者(95.24%vs 72.22 vs 40.74%、85.71%vs 74.07%vs 59.26%、95.23%vs 87.04%vs 74.07%;P<0.05);根据出院时格拉斯哥预后量表(GOS)评分,将患者分为预后良好组(87例)和预后不良组(15例)。预后良好组和预后不良组两组患者的年龄、高血压史、术前颅内血肿量、动脉瘤大小、术前Hunt-Hess分级、手术时机、术后并发症、美国国立卫生研究院卒中量表(NIHSS)评分差异均具有统计学意义(P<0.05),均是影响IA患者术后预后的独立危险因素;列线图模型预测患者预后不良率为14.71%,模型评价的实际C-index为0.815,内部验证C-index为0.809,外部验证C-index为0.805,模型符合度较好。结论IA患者动脉瘤破裂后越早(24 h内)进行显微夹闭手术疗效越好,患者年龄、高血压史、术前颅内血肿量、动脉瘤大小、术前Hunt-Hess分级、手术时机、术后并发症、NIHSS评分均是影响IA患者预后不良的独立危险因素。

Objective To explore the efficacy of microclamping surgery at different times for treatment of intracranial aneurysms(IA)and analyze factors affecting prognosis.Methods From January 2017 to January 2019,102 IA patients performed microclamping surgery were enrolled,which included 49 males and 53 females,aged 33-72 years old with mean age of 56.54 years old.The general data,postoperative aneurysm clipping,postoperative complications,treatment effect and prognosis of patients with microscopic clipping at different times(within 24-hour,48-hour and 72-hour)were compared.The univariate and multivariate Logisitic regression were used to analyze the factors affecting prognosis of IA patients;according to screened independent risk factors,the nomogram prediction model were constructed and verified.Results There was no statistically significant difference in general information of patients with microscopic clipping at different times(P>0.05);the complete clipping rate,good recovery rate and good prognosis rate of patients performed aneurysms operation within 24-hour were significantly higher than those within 48-hour and 72-hour(95.24%vs 72.22 vs 40.74%,85.71%vs 74.07%vs 59.26%,95.23%vs 87.04%vs 74.07%;P<0.05).All patients were divided into good prognosis group(n=87)and poor prognosis group(n=15)by Glasgow Outcome Scale(GOS)score at discharge.There were statistical differences in age,hypertension history,preoperative intracranial hematoma,aneurysm size,preoperative Hunt-Hess classification,operation timing,postoperative complications and National Institutes of Health Stroke Scale(NIHSS)scores between 2 groups(P<0.05),which were all independent risk factors affecting postoperative prognosis of IA patients.The poor prognosis rate of patients predicts by nomogram model was 14.71%,the actual C-index evaluated was 0.815,internally verified C-index was 0.809 and externally verified Cindex was 0.805,which with good model conformity.Conclusion It is demonstrated that the sooner microclamping performed in IA patients after the aneurysm rupture(within 24-hour),the better the effect will be.The age,hypertension history,preoperative intracranial hematoma volume,aneurysm size,preoperative Hunt-Hess classification,and timing of surgery postoperative complications and NIHSS score are all independent risk factors for poor prognosis of IA patients.